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NHS England announces rescue plan for A&E departments

NHS England has announced a rescue plan for struggling A&E departments and the creation of new urgent care boards across England - including GPs, consultants and patient representatives - to ensure emergency services are working properly and to vet the quality of local NHS 111 services.

The announcement comes after the governing body found that there was ‘no single trend or factor’ to explain the deterioration in A&E departments, despite Government ministers insisting that ‘poor primary care provision’ was to blame for a rise in A&E attendances.

In the plan, NHS England admitted for the first time that the troubled rollout of the NHS 111 service has contributed to the rising pressure on emergency services, but also added that a ‘perceived lack’ of availability of primary care and out-of-hours care could have added to the pressure on A&E departments.

It said the plan it has put together to tackle the issue in the short term will be followed by a longer term plan drawing on the ongoing review into urgent care which is being led by Sir Bruce Keogh.

The new urgent care boards - due to be formed by the end of the month - will be led by NHS England’s local area teams and have been tasked to ensure that all services involved are reviewed by the CCG, including the effectiveness of primary care, GP out-of-hours care and admission avoidance schemes.

The boards will report nationally to NHS England, Monitor and NHS Trust Development Authority, will also be responsible for ensuring the quality of local NHS 111 services. NHS England referred to planning guidance from last December that gave it powers to intervene in CCG’s commissioning of urgent care if their providers were ‘not maintaining a sufficient level of performance’.

In the last quarter of 2011/12, 47 out of 152 providers failed to meet the 95% standard for patients being seen and discharged within four hours. For the last quarter of 2012/13 this figure had increased to 94 out of 148 providers, double the previous number.

NHS England said a number of factors ‘are assumed to have played a part’ in the deterioration including: more patients arriving at A&E; hospitals being less proactive and more delayed discharges because primary, community or social care services are not in place.

It added that these factors were likely to have been worsened by a ‘perceived lack’ of availability of primary care and community services out of hours, a lack of beds and staff in hospitals as they tried to cut costs and the introduction of NHS 111 (see box below).

The document said: ‘Long waiting times in A&E departments not only deliver poor quality in terms of patient experience, they also compromise patient safety and reduce clinical effectiveness.

‘Despite much analysis there is no single trend or factor to explain the deterioration and there remains a wide variation in performance both across the country and within the same areas where similar factors apply.

‘A number of factors are assumed to have played a part in this deterioration, and not all of them pertain to every situation… There are also many assumptions as to why these factors have played a greater part than in previous years.

‘Working closely with other key stakeholders, and building on the views already shared from CCGs and providers, NHS England will put in place an approach that will support the emergency and urgent care system, reduce pressure and ensure that patients do not have to wait longer than the agreed standards as identified in the NHS constitution and thus meet the national operating target of 95%.

‘This document outlines the overall approach and identifies the actions which area directors should now put in place to ensure that the commissioning system responds appropriately to support providers of A&E and urgent care services.’

Potential reasons for deterioration in A&E department performance

- Perceived lack of availability of primary care and community services out of hours

- Lack of beds and staff in hospitals as they tried to cut costs

- Commissioners lacking focus and clarity during the 1 April transition to the new commissioning system

- Pressure on social care budgets

- Introduction of NHS 111

Source: NHS England

Readers' comments (8)

  • Yippieee. Another talking shop masquerading as a solution. Im sure thats going to solve the problem.

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  • This is what I don't get: If,as Mr Hunt suggested primary care was to be blamed for this and has evidence GPs have failed to meet their contracted work, why doesn't he just terminate the contract of all failed providers (i.e. GP practice) as he would be entitled to do. Or as a very least, increase primary care funding to be bale to tackle this issue.

    Perhaps, it is as shown above, primary care is not to be blamed for the failure? Eitherway, increasing number of beurocrats, managers, board members, guidance and quangos, catch phrases, and media spin doctors will not resolve the problem.

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  • No one seems to be looking at the big elephant in the room - the patients! Learned helplessness, government spin driving unrealistic expectations of what a crumbling NHS can offer, little if any effort being pushed in the direction of patients/public taking some responsibility for their health and the way they misuse the service, and media scaremongering. 40% of AE admissions on the weekends are due to alcohol...such a blindingly obvious thing to target...but all I hear is blah, blah, blah.

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  • And the other elephant, the fact that it is more cost effective for CCGs to allow increasing ED attendances. They only pay 30% of tariff f

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  • (Contd) The CCGs are supposed to invest the 70% in community services but there is no monitoring of this, and instead they just get the care on the cheap, leaving the hospitals with all the clinical risk and underpaying them. It's a scandalous situation.

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  • The REAL ELEPHANT IS UN DEFINED WORKLOAD. Poor provision by GPs may or may not be true. How can we judge? We have 2 different points of view. GPs are saying they are over worked,stressed and retiring. Mr. Hunt says their provision is inadequate and they are over paid.
    Is there an independent yardstick ? So, how many patients does a GP see in a day ? How many hours does he work ? How much does he profit from each consultation? On average. Is this enough or should GPs do more? Please define and be specific so all can judge and know which view is right.

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  • So much for no more top down and the CCGs are in charge. Dictatorship has returned after just one and a half months.

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  • That's a really good idea - another board!
    Someone somewhere needs to say to patients that their first port of call in core hours is to their GP and if they go to ED they will be turned away. GP's have to repatriate these patients. Close all WIC to reduce choice and spend the money on surgeries. Patients currently have at least 5 choices for face to face consultations and no-one in the system is saying 'hey chummie thats not the way it works - if you are ill you go there and jolly well join the queue unless you are actually dying of course'

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